To assess the clinical effect of HA regimen on newly diagnosed patients in chronic phase of chronic myeloid leukemia (CML). Ninety four cases of CML patients were grouped in accordance with the requirements on the basis of treatment regimens and Sokal risk index, and the clinical effects of HA regimen wer evaluated. We found that HA regimen showed satisfactory immediate effect on CML in chronic phase. CR rates achieved in high risk and medium risk groups(77 4%,20 0%) with HA were higher than that with Hu regimen(35 0%,0%). However, HA regimen was incapable of extending the duration of CML. So HA should not be used as first line treatment in the treatment on newly diagnosed patients in chronic phase of CML, except for high risk group whose symptoms could not be controlled with other regimens.

Objective To evaluate the effectiveness of using high-fidelity simulator (HFS) in medical training of cardiopulmonary resuscitation (CPR).Methods The randomized controlled trials (RCTs),quasi-randomized controlled trials (q-RCTs) about comparing HFS with traditional teaching methods in medical training of CPR were searched from Cochrane Library,Pubmed,Web of Knowledge,CNKI,CBM and Wanfang Data.The methodological quality of the included studies was assessed and the valid data were extracted.Meta-analysis was conducted with the Cochrane Collaboration RevMan 5.0.Results Ten q-RCTs and one RCT were included.The quality of the studies were relatively low.Meta-analysis showed that compared with the traditional teaching method,high-fidelity simulation in medical training of CPR had no statistically significant differences in mastering the theoretical knowledge,but had statistically significant differences in mastering the CPR skills.Conclusions HFS in medical training of CPR skills is positive and effective,superior to the traditional teaching methods,but in terms of theoretical knowledge and satisfaction,self-confidence,more researches still need to be further confirmed.

We investigated the third-generation cephalosporins-resistant Shigella and its genotype in Ningbo,China,providing a basis for disease prevention and control.Pathogenic bacteria were analyzed by direct isolation combined with enrichment culture isolation.Antimicrobial susceptibility was determined by K-B disk diffusion method and PCR was used for detecting multidrug resistance genes like CTX-M,OXA,TEM and SHV.BLAST analysis was used to determine the genotype.Results showed that 69 strains of third-generation cephalosporins-resistant Shigella were detected by drug sensitivity screening,accounting for 74.19％ of ESBLs Shigella.Drug resistance gene CTX-M(CTM-M-1 and CTM-M-9),OXA and TEM were detected.The detection rate were 79.71％,79.01％ and 26.09％ respectively.With no CTX-M-2 and SHV,DNA sequence alignment showed CTX-M-1 group were mainly of CTX-M-15 type besides seven other types;CTX-M-9 group were mainly of CTX-M-14 type besides six other types;49 strains of OXA and 18 strains of TEM were sequenced to be type 1 (OXA-1 and TEM-1 type).The 21 Shigella strains carrying more than two drug resistance genes accounts for 30.43 ％.Shigella in Ningbo has high third-generation cephalosporins-resistance rate and many kinds of ESBLs enzymes were detected.The mainstream enzyme type was CTX-M,meanwhile they also carried a variety of drug resistance genes,which could bring difficulties to disease prevention and control.The high carrying rate of OXA-1 type suggests that we should pay more attention.The detection rate of group B was higher than that of group D,including not only the phenotype resistance but also the drug-resistance genes;these findings will be useful in the study of the drug resistance prevalence of Shigella.

Aim Toinvestigatetheantagonisticeffect of intrathecal injection of carbenoxolone (CBX ) on neuropathic pain and its underlying mechanism.Meth-ods SixtymaleSprague-Dawleyratswererandomly divided into five groups (n =12 ):group I received sham surgery then treated with saline;group Ⅱ re-ceived SNT then treated with saline;groupⅢreceived SNT then treated with 0. 05 μg CBX;group Ⅳ re-ceived SNT then treated with 0. 5 μg CBX;group Ⅴreceived SNT then treated with 5 μg CBX.Treatment was undertaken with 10 μl volume as a single intrathe-cal injection on postoperative day 10.Mechanical with-drawl thresholds were measured 1 d before operation, 1,3,5,7 and 10 d after surgery,1 h before intrathe-cal administration,and 1 ,2,4,6 h after intrathecal administration.Lumbar spinal cord was obtained 2 h after intrathecal administration to determine the expres-sions of GFAP by immunohistology and TNF-α,IL-1βby ELISA in bilateral spinal dorsal horns.Results Comparedwiththeshamgroup,thebilateralMWTin group Ⅱ ~Ⅴ was significantly decreased.Compared with the MWT 1 h before intrathecal administration on day 10,the values at 1 ,2,4,6 h after administration of group Ⅱ and Ⅲ had no marked difference.The ip-silateral MWT in groupⅣhad no significant difference at 1,2,4 h after administration,the contralateral MWT was significantly increased,whereas GFAP and TNF-α,IL-1βwas significantly decreased in the spinal cord .In group Ⅴthe bilateral MWT was significantly improved at 1 ,2,4 h after administration,whereas GFAP and TNF-α,IL-1βwere significantly decreased inthespinalcord.Conclusions IntrathecalCBXcan inhibit the development of bilateral MWT.The analge-sic effect of CBX is implemented partly via suppressing the actation of GFAP and the realease of TNF-α,IL-1βin the spinal doral horn.

OBJECTIVETo evaluate the effect of mycophenolate mofetile (MMF) on acute graft versus host disease (aGVHD) prophylaxis after allogeneic bone marrow transplantation (allo-BMT) in a murine model.

METHODSAcute GVHD was induced in male BALB/c mice by total-body irradiation (TBI) followed by female allogeneic (C57BL/6J) bone marrow and spleen cells transplantation. Acute GVHD was assessed both physically and histologically. Severe aGVHD was developed in the recipients and the mean survival time (MST) of untreated BM recipients was 6 days. After allo-BMT, animals were divided into 6 groups. Group 1 was given MMF (30 mg.kg(-1).d(-1)), group 2 CsA (1.5 mg.kg(-1).d(-1)) and MTX (0.4 mg.kg(-1).d(-1)), group 3 MMF (30 mg.kg(-1).d(-1)) in combination with CsA and MTX, group 4 MMF (60 mg.kg(-1).d(-1)) in combination with CsA and MTX, group 5 MMF (10 mg.kg(-1).d(-1)) in combination with CsA and MTX, and group 6 no agents for aGVHD prophylaxis. The physical signs, MST, peripheral blood counts, and aGVHD histopathologic examination were observed in all recipients.

RESULTSAnimals in control group developed typical aGVHD and 100% of mortality, with a MST of 6 days. The MSTs of group 1 approximately 5 were significantly longer than that of control, being 3.4, 8.4, 9.0, 6.1 and 8.8 days longer, respectively (P < 0.05). The MSTs of groups 2 approximately 5 were longer than that of group 1 (P < 0.05), but there was no statistical significance between groups 3 approximately 5 and 2. There was no statistical difference in peripheral blood count among groups 1 approximately 5. Histopathological examination of skin, liver, and gastrointestinal tract showed typical signs of aGVHD. Animals received immunosuppressive agents (MMF, CsA, MTX) showed the less severe signs.

CONCLUSIONSMMF markedly prolonged MST of allo-BMT recipients, delayed the onset of aGVHD signs. The prophylaxis effect of CsA + MTX with or without MMF was better than that of MMF alone, synergism between MMF of 10 or 30 mg.kg(-1).d(-1) and CsA + MTX was better than that of MMF of 60 mg.kg(-1).d(-1) and CsA + MTX.

Animals ; Bone Marrow Transplantation ; Cyclosporine ; pharmacology ; Dose-Response Relationship, Drug ; Drug Synergism ; Female ; Graft Survival ; drug effects ; Graft vs Host Disease ; pathology ; prevention & control ; Immunosuppressive Agents ; pharmacology ; Methotrexate ; pharmacology ; Mice ; Mice, Inbred C57BL ; Models, Animal ; Mycophenolic Acid ; analogs & derivatives ; pharmacology ; Time Factors ; Transplantation, Homologous

Objective To improve overall value of healthcare industry through setting up critical inpatient medical services strategic plan.Methods Identify major objectives which the local government expects to achieve through strategic map; Standardize inpatient output and assign weight to each group through diagonosis related groups; Translate the objectives of strategic map and result of diagnosis related group to Balanced Score-card; Finally build up strategic map and according action plans.ResultsPreliminarily established 16 objectives、23 measures and 13 tasks in four perspectives including customer,internal work flow,learning and growing and finance.ConclusionThe strategy map and the balanced score-card can help implement full strategic plan of regional inpatient medical services; DRGs is a core management tool of patient-centred service output management; Balanced Score-card is able to realize continuous improvement of Beijing inpatient medical services from macro to micro persoetive.

Objective To improve fresh nurses′ implementation rate of standard clinical administration checking by applying situational simulation method, and enhancetheir ability of identifying hidden perils in nursing. Methods Totally 75 fresh nurses who graduated in 2016 were enrolled and divided into two groups (36 in control group and 39 in experimental group) according to randomized digital table method. Situational simulation method was applied in the experimental group, while the control group applied traditional nursing safety check training method. Then both groups′ satisfaction rate of lessons and self-confidence after training were recorded. Besides, their clinical administration checking behaviors after 3 months, the errors, hidden perilsand examining situations related to administration checking after 6 months,were also evaluated. Results Significant statistical differences were shown in satisfaction score (23.62 ± 2.02 in experimental group vs. 21.39 ± 1.98 in control group, t=4.818, P<0.01) and self-confidential evaluating score (35.67±2.02 in experimental group vs. 21.39±1.98 in control group, t=2.768, P<0.01). Observation of clinical administration checking behaviors 3 months after training had indicated significant differences in the number of nurses who check drug concentration (33 vs. 8, χ2=29.406, P<0.05) and executing time (30vs. 12, χ2=14.436, P<0.05).Statistical differences (χ2= 5.080-29.545, P< 0.01 or < 0.05) were also observed in the number of nurses checking bed number, patient name, drug name, dose, drug concentration and methods in and after operation. The potential nursing perils identified, and the number of nurses who identify hidden nursing perils 3 months and 6 months after training were significantly larger (χ2=50.591, 23.658, 3.914, P<0.05) in experimental group (33, 2, 10) than in control group (18, 1, 3),and there were no significant differences in the rate of potential perils and nursing error between both groups. Conclusion Situational method of administration, which is applied for fresh nurses in their initial working phase, transforms the basic and core checking system into clinical real-situation cases. It also shows an advantage of boosting their self-confidence of learning, improving the implementation rate of standard clinical administration checking and the ability of avoiding potential nursing perils.

Objective:To construct an artificial intelligence (AI)-assisted system based on deep learning for corneal in vivo confocal microscopy (IVCM) image recognition and to evaluate its value in clinical applications. Methods:A diagnostic study was conducted.A total of 18 860 corneal images were collected from 331 subjects who underwent IVCM examination at Renmin Hospital of Wuhan University and Zhongnan Hospital of Wuhan University from May 2021 to September 2022.The collected images were used for model training and testing after being reviewed and classified by corneal experts.The model design included a low-quality image filtering model, a corneal image diagnosis model, and a 4-layer identification model for corneal epithelium, Bowman membrane, stroma, and endothelium, to initially determine normal and abnormal corneal images and corresponding corneal layers.A human-machine competition was conducted with another 360 database-independent IVCM images to compare the accuracy and time spent on image recognition by three senior ophthalmologists and the AI system.In addition, 8 trainees without IVCM training and with less than three years of clinical experience were selected to recognize the same 360 images without and with model assistance to analyze the effectiveness of model assistance.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2021-K148).Results:The accuracy of this diagnostic model in screening high-quality images was 0.954.Its overall accuracy in identifying normal/abnormal corneal images was 0.916 and 0.896 in the internal and external test sets, respectively.Its accuracy reached 0.983, 0.925 in the internal test sets and 0.988, 0.929 in the external test sets in identifying corneal layers of normal and abnormal images, respectively.In the human-machine competition, the overall recognition accuracy of the model was 0.878, which was similar to the average accuracy of the three senior physicians and was approximately 300 times faster than the experts in recognition speed.Trainees assisted by the system achieved an accuracy of 0.816±0.043 in identifying corneal layers of normal and abnormal images, which was significantly higher than 0.669±0.061 without model assistance ( t=6.304, P<0.001). Conclusions:A deep learning-based assistant system for corneal IVCM image recognition is successfully constructed.This system can discriminate normal/abnormal corneal images and diagnose the corresponding corneal layer of the images, which can improve the efficiency of clinical diagnosis and assist doctors in training and learning.

Objective: To study the effect of WT1 expression on the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute leukemia (AL) and its significance as molecular marker to dynamically monitor minimal residual disease (MRD) . Methods: Retrospectively analyzed those AL patients who underwent allo-HSCT in the First Hospital Affiliated to Zhejiang University School of Medicine during Jan 2016 to Dec 2017, a total number of 314 cases, 163 males and 151 females, median age was 30 (9-64) years old. Comparing the difference of WT1 expression at diagnosed, pre-HSCT and after HSCT. Using the receiver operating characteristic (ROC) curve to determine the WT1 threshold at different time so as to predict relapse. The threshold of WT1 expression before transplantation was 1.010%, within 3 months after HSCT was 0.079% and 6 months after HSCT was 0.375%. According to these thresholds, WT1 positive patients were divided into low expression groups and high expression groups. Analyzed the relationship between overall survival (OS) , disease-free survival (DFS) , cumulative incidence of relapse (CIR) and WT1 expression. Results: The OS and DFS of high expression group pre-HSCT were lower than low expression group [69.2% (9/13) vs 89.1% (57/64) , χ²=4.086, P=0.043; 53.8% (7/13) vs 87.5% (56/64) , χ²=9.766, P=0.002], CIR was higher than low expression group [30.8% (4/13) vs 7.8% (5/64) , P=0.017]. There was no significant difference of OS and DFS between high expression and low expression group of 3 months after HSCT (P=0.558, P=0.269) . The OS and DFS of high expression group of 6 months after transplantation were both lower than low expression group (P=0.049, P=0.035) . Multivariate analysis showed that WT1>0.375% when 6 months after transplantation was the only independent prognostic factor for shorter DFS (P=0.022) . There was no statistically significant difference in CIR between the high-expression group and the low-expression group 3 months after transplantation and 6 months after transplantation (P=0.114, P=0.306) . Conclusion High expression of WT1 before and after HSCT was an adverse prognosis factor. It is of clinical practical value to use WT1 as a transplant recommendation index for patients with acute leukemia and as a marker to monitor MRD dynamically.

Objective: To investigate whether it can reduce the incidence of pressure ulcer caused by ICU equipment, when nurses in ICU use the SKIN model framework to carry out preventive and nursing measures. Methods: To construct the teaching group of nursing workshop based on SKIN mode for preventing pressure ulcer caused by ICU equipment and train 36 ICU nurses. Before and after training course, to collect the behaviors of preventing pressure ulcer caused by ICU equipment during clinical work time and the incidence and severity of pressure ulcer. Results: The nurses′ behaviors of controlling skin status of patients who use Bi-level positive airway pressure non-invasive mask and evaluating nutritional status of patients change a lot (χ²=34.420,10.123, P <0.01). The nurses′ behaviors of checking and evaluating skin status of patients who have stomach tube to reduce skin pressure, shear and friction and assessing nutritional status of patients were improved (χ²=7.547-49.451, P <0.05). The nurses′ behaviors mentioned above of nursing patients who have oral air tube were also changed significantly (χ²=5.225, 23.402, 12.444, P<0.05 or 0.01). The incidence of pressure ulcer caused by ICU equipment dropped from 2.86%(100/3 502) to 1.87%(67/3 580) (χ²=7.445, P<0.05). The decrease in incidence of Ⅱand Ⅲ grade pressure ulcer are from 48%(48/100) to 22.39%(15/67) and 34%(34/100) to 7.46%(5/67) respectively and had significant differences as well (χ²=11.202, 15.784, P<0.01). Conclusions This study explains the training approach based on SKIN mode of prevention of pressure ulcer caused by ICU equipment. The results show that the training approach can decrease the incidence and severity of pressure ulcer caused by ICU equipment, improve the nurses′ nursing behaviors and promote the transform of theory related to pressure ulcer from basement to clinical reality.